{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:04:00Z","timestamp":1793048640947,"version":"4.5.0"},"reference-count":87,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230330-4\"><jats:title>Importance<\/jats:title><jats:p>The incidence of early-onset colorectal cancer (CRC), diagnosed younger than 50 years of age, has increased worldwide. Gut dysbiosis throughout the life course is hypothesized as a leading mechanism, yet epidemiologic data are limited.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230330-5\"><jats:title>Objective<\/jats:title><jats:p>To prospectively examine the association between birth by cesarean delivery and early-onset CRC among offspring.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230330-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>In this population-based, nationwide case-control study in Sweden, adults diagnosed with CRC between 18 and 49 years of age from 1991 to 2017 were identified through the Epidemiology Strengthened by Histopathology Reports in Sweden (ESPRESSO) cohort. Up to 5 general population control individuals without CRC were matched with each case on age, sex, calendar year, and county of residence. Pathology-confirmed end points were linked with the Swedish Medical Birth Register and other national registers. Analyses were conducted from March 2022 through March 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230330-7\"><jats:title>Exposure<\/jats:title><jats:p>Birth by cesarean delivery.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230330-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was development of early-onset CRC in the overall population and by sex.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230330-9\"><jats:title>Results<\/jats:title><jats:p>We identified 564 case patients with incident early-onset CRC (mean [SD] age, 32.9 [6.2] years; 284 [50.4%] male) and 2180 matched controls (mean [SD] age, 32.7 [6.3] years; 1104 [50.6%] male). Compared with vaginal delivery, birth by cesarean delivery was not associated with early-onset CRC in the overall population (adjusted odds ratio [aOR], 1.28; 95% CI, 0.91-1.79) after multivariable adjustment for matching and maternal and pregnancy-related factors. A positive association was found for females (aOR, 1.62; 95% CI, 1.01-2.60), but there was no association for males (aOR, 1.05; 95% CI, 0.64-1.72).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230330-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this nationwide, population-based case-control study, birth by cesarean delivery was not associated with early-onset CRC compared with birth by vaginal delivery in the overall population in Sweden. However, females born by cesarean delivery had greater odds of early-onset CRC compared with individuals born through vaginal delivery. This finding suggests that early-life gut dysbiosis may contribute to early-onset CRC in females.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.10316","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T15:35:44Z","timestamp":1682609744000},"page":"e2310316","source":"Crossref","is-referenced-by-count":20,"title":["Evaluation of Birth by Cesarean Delivery and Development of Early-Onset Colorectal Cancer"],"prefix":"10.1001","volume":"6","author":[{"given":"Yin","family":"Cao","sequence":"first","affiliation":[{"name":"Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri"},{"name":"Alvin J. 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Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara B.","family":"Warner","sequence":"additional","affiliation":[{"name":"Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Stephansson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Women\u2019s Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas F.","family":"Ludvigsson","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Paediatrics, \u00d6rebro University Hospital, 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